Healthcare Provider Details

I. General information

NPI: 1912318742
Provider Name (Legal Business Name): HEATHER KALE MSW, LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2014
Last Update Date: 07/14/2020
Certification Date: 07/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5910 SHINGLE CREEK PKWY STE 150
MINNEAPOLIS MN
55430-2324
US

IV. Provider business mailing address

5910 SHINGLE CREEK PKWY
MINNEAPOLIS MN
55430-2322
US

V. Phone/Fax

Practice location:
  • Phone: 763-569-5200
  • Fax:
Mailing address:
  • Phone: 763-569-5200
  • Fax: 763-746-2401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number27679
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: